Ep056: Insomnia is NOT Sleep Loss?! -- with Dr. Grandner

deepintosleep.co

Time Stamps

2:35 Is insomnia equal to losing sleep?

6:17 How does insomnia and sleep deprivation impact our health?

10:01 How does insomnia and sleep deprivation affect our work?

11:53 How do you prioritize sleep?

13:18 How do I know if I have insomnia or if I am losing sleep?

19:21 Can caffeine affect my sleep?

20:59 What is more effective than caffeine consumption?

21:14 What is a power nap?

22:55 What can improve my sleep?

TODAY’S GUEST

Michael Grandner, PhD, is the Director of the Sleep and Health Research Program at the University of Arizona and Director of the Behavioral Sleep Medicine Clinic at the Banner-University Medical Center in Tucson, AZ. He also serves as an Assistant Professor in the Departments of Psychiatry and Medicine in the UA College of Medicine, Assistant Professor of Psychology in the UA College of Science, and Assistant Professor of Nutritional Sciences in the College of Agriculture and Life Sciences. He is Certified in Behavioral Sleep Medicine by the American Board of Sleep Medicine and is a Diplomate in Behavioral Sleep Medicine by the Board of Behavioral Sleep Medicine.

His research focuses on real-world implications of sleep and health, and how sleep and sleep-related behaviors are related to cardiovascular disease, diabetes, obesity, neurocognitive functioning, mental health, and longevity.

WHAT WILL WE LEARN

A lot of times, when we cannot fall asleep, we are worried that we will lose sleep, which may impact our health negatively. This equation: insomina = sleep loss, causes quite a lot of anxiety about sleep. Is this true? In this episode, these questions were discussed:

  • What is insomnia?

  • Is insomnia equal to losing sleep?

  • How does poor sleep impact us?

  • Sleep is an investment, not a waste of time

  • The way you need to function the next day should determine what time you go to bed the night before.

RESOURCES

Click to read more on Dr. Grandner’s website

You can find Dr. Grandner’s book “Sleep and Health” on Amazon

Dr. Grandner’s Twitter

Dr. Grander’s Instagram

Dr. Grandner’s Facebook page

Dr. Grander’s LinkedIn page

Thank You for Listening!

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Transcripts

yishan xu  0:00  

Hey, welcome to another episode of Deep Into Sleep. I'm your host Yishan. If you are unable to sleep, and you worry about losing sleep, then you are probably wrong about it. If you are trying to stay up late and finish some work and hope to have great productivity the next day, and be super sharp on top of your game, you are probably making a mistake also. What's worse is, no matter how much coffee you drink, it won't help you to be more sharp, unfortunately. Now you may be confused. What so unable to sleep is different from losing sleep? And coffee does not help us the way we think it should? And if we have a lot of work to finish at night, we should hold it off? What?

I know, I know a lot of question marks right. So today, our guest, Dr. Michael Grandner will explain all this to us. What's the science behind all this? And what we could do to help ourselves to sleep better, be healthier, and be more productive. Dr. Grandner is the director of Sleep and Health Research Program at the University of Arizona. He's also the director of the Behavioral Sleep Medicine Clinic at banner University Medical Center in Tucson. He is certified in Behavioral Sleep Medicine by the American Board of Sleep Medicine. He's also the author of the book "Sleep and Health". I learned a lot from this short conversation with him. And I'm sure you would love it too. Let's dive in. Hi, Dr. Grandner. Welcome to deep into sleep.

Dr. Grandner  1:55  

Hello, thank you for having me.

yishan xu  1:57  

So I know you're an expert in the sleep medicine field, and you treat a lot of disorders like insomnia, that those kind of sleep disorders. So for I have a question for you. A lot of people when they hear insomnia, they will saying, Well, if I have insomnia, I cannot sleep very well. I definitely am losing my sleep, right? And that's severe. And I want to ask you, is that right? Is insomnia equal to losing sleep?

Dr. Grandner  2:35  

That's a great question. So the way I'd like to answer that is to talk about the difference between insomnia and sleep deprivation. So insomnia means that you're having difficulty falling asleep, or you wake up and can't get back to sleep. So that means that either when you lay down to try and fall asleep, it takes you a long time. Or maybe you wake up during the night, and then you can't get back to sleep, or you wake up too early in the morning and can't get back to sleep. That's insomnia. In addition to that, insomnia also means you have some problems during the day. So the problem sleeping causes you either like stress or difficulty focusing or difficulty staying away, or, or fatigue or anything, it has to cause a daytime problem. And it has to happen at least three nights a week. So if it if it happens one or two nights a week, I don't know that I would call that like a real insomnia. It might be like an insomnia problem, but not a real insomnia disorder. And if it's been going on for at least three months, we would actually give you a diagnosis of insomnia disorder. Or if it's been less than three months, we would call it like a short term insomnia that will either resolve on its own or could turn into a long term insomnia. Now that's insomnia, insomnia is difficulty falling asleep, or difficulty staying asleep. But notice, one thing I didn't say in there is how much you sleep. There are some people in insomnia who get four or five hours of sleep. And in addition to the insomnia, they're also sleep deprived. There's a lot of people who have insomnia who actually get, you know, seven hours of sleep, but they still have insomnia, or maybe even longer than seven hours, actually, after about seven, eight hours, actually, longer sleep actually correlates with more insomnia, strangely, so the amount of sleep you get, and insomnia are two totally different things. It's like, if you don't eat enough, you won't get enough nutrition, so you'll be nutritionally deprived. But if you eat a lot, but still don't have good nutrition, okay, you're eating enough, but it's still not good quality. And so insomnia is more about the quality of like the nutrition for food. And sleep deprivation is are you eating enough to give yourself enough energy? So that's why there's two different dimensions. Some people with insomnia have insomnia And sleep deprivation. Some people are just sleep deprived. So a lot of people who are sleep deprived have no insomnia, because they're super tired and sleepy, because they're so sleep deprived. So they're starving for sleep. So whenever they get into bed, they fall asleep right away. And then their alarm goes off, and they have to get up and start the day. And so they don't have insomnia. They just have sleep deprivation. Some people have both, and some people just have insomnia.

yishan xu  5:26  

I see. So sounds like insomnia and sleep deprivation there for some people, there's some kind of overlap. But for some people, they can either have this one or that one, not both.

Dr. Grandner  5:38  

Yeah, so some have one. And some have both some, a lot of people don't have either one. But people confuse them a lot. Because a lot of people with insomnia, they feel like their problem is that they're not getting enough sleep. Not that the sleep is poor quality, when actually that might be the problem.

yishan xu  5:54  

So sleep quality feels different. And it's different than sleep quantity.

Dr. Grandner  6:02  

Correct.

yishan xu  6:04  

Then how insomnia and sleep deprivation impact our health? I know that a lot of people really worry about that. They think if I sleep poorly, I have insomnia that my health is gonna suffer.

Dr. Grandner  6:17  

Yeah, that's a great question. So insomnia itself is a major risk factor for mental health problems. So probably the the most common. The most common risk factor for insomnia is developing depression, and anxiety disorders. But there's also a bunch of scientific evidence that shows insomnia itself can increase risk for things like high blood pressure, or getting sick more, or even even diabetes, especially in in men more than women, there seems to be some other health risks associated with insomnia to not so not only just mental health, but it seems to be the strongest risk factors with insomnia with mental health. Sleep deprivation, on the other hand, has some risks with mental health. But the risks associated with sleep deprivation are a little more physical things like weight gain, obesity, high blood pressure, diabetes, inflammation, and getting sick more. And also things like ability to focus and brain function. So people with insomnia, who don't, who aren't sleep deprived can feel foggy during the day, but they're actually they're often able to perform okay, but people who are sleep deprived, ironically, often feel like they're doing okay, but they're actually quite impaired. For example, we did a study looking at drowsy driving, showing that the amount of sleep you get predicts drowsy driving, not how well rested, you think you are. And so and so when you have both. And that might mean that you have both sets of risks. So you might have the risks of insomnia plus the risks of sleep deprivation. And and so that might be especially troubling.

yishan xu  8:13  

Oh, that's very interesting. So sounds like objectively, subjectively, how we feel and what actually how we are sleeping there sometimes there's a gap?

Dr. Grandner  8:24  

Yeah, a lot of people, especially people who've been sleep deprived for a while when you bring people into the laboratory, so it's a great, there's been a number of great studies on this, one of my favorite studies actually came out of Singapore, for what they did is what a great research sleep research program done there. One of the things they did is they took people, and they sleep deprived them for a few nights. And they showed that their brain function got worse and worse and worse, they were less able to focus, pay attention. And then what they did is they gave them a couple nights of rest, like a weekend. And then their scores went back down to normal. But then what happened as soon as they sleep deprived them again. Instead of starting from normal again, they actually started from worse. So so they didn't actually fully recover. And then when you also ask people how they're doing in these studies, you can see that after a few days, people think they're adjusting to less sleep. Ah, my body's just getting used to it. But it turns out, you're actually scoring worse and worse and worse, even if you think you're recovering and leveling off. So it's really important to know that the more impaired you are, the less able to tell how impaired you are like the sleep deprivation not only causes you to have problems, but one of the problems is you can't tell that you sleep you're sleep deprived anymore, because you're so used to it.

yishan xu  9:43  

Wow, that's very scary, right? Especially now. We all work so hard. I know a lot of people are so tired but very career driven work very until very late to possibly very common problems nowadays.

Dr. Grandner  10:01  

yeah, well and and sleep deprivation and insomnia I should mention, both have there's a whole literature now emerging how both of these impact work, people with insomnia who say they have difficulty sleeping, not only do they have less productivity, and they're they've higher health care costs, they call out sick more, they get injured on the job more, and they're more likely to go on disability. We also in some of our data, we showed that people with insomnia, so everyone loses productivity from stress, or co worker issues or family, we all lose productivity from a bunch of different sources. People with insomnia lose twice as much productivity as people who don't have insomnia from the same sources. And we also showed that caffeine doesn't totally fix that problem. Either. It can increase reaction time and speed, but it doesn't fix productivity. And we found the same thing with sleeping less. So a lot of people sleep less, to work more. But it turns out, when you sleep less, you become less efficient, and you make more mistakes. So actually, the people who slept a little more, lose less productivity, and they actually gain more efficiency. So they actually get more done in less time. So maybe one of the reasons why you don't feel like you have enough time for sleep is because you're not sleeping enough and you're being inefficient. So rather than sleep being a cost, at the end of the day, you should see sleep as an investment in tomorrow's productivity and functioning.

yishan xu  11:32  

Oh, I love that. I love that mindset, we really should view sleep as an investment is much stronger statement than what I used to think we should all prioritize sleep, was thinking about something you are investing in yourself actually gets you more productive, not the other way around.

Dr. Grandner  11:52  

Yeah, right. And so when when I decide when to go to bed at night, it's not how much work Do I still have left to do? It's how productive and awake Do I need to be tomorrow, if I need to be functioning really well, I need to make sure I put down whatever it is I'm doing get to sleep, whatever it is, is going to have to wait. Because if I don't want to kill my whole tomorrow, for an extra half an hour, or an hour, or even an hour and a half of productivity tonight, because I'm going to lose that same time tomorrow, and it's going to be a cycle. So I would I would urge people to choose when they're going to bed based on how functional they want to be tomorrow, not based on how much work they have left. And often they'll find that all that time they didn't think they had they get it back. They'll find it by being more productive and being more efficient.

yishan xu  12:43  

That's great suggestion people really should keep in mind, I think that's so important. Thank you for for telling our audience that. Yeah, so I really like how you schedule your sleep and work and think about productivity that way. But I know for a lot of our audience possibly is quite challenging for them to gain some insight to be aware of, you know, where my sleep is? Do I really have insomnia? Am I losing sleep, too? How do I know?

Dr. Grandner  13:18  

Yeah, so here's a couple good rules of thumb for you. If it takes you more than a half an hour to fall asleep, or you're awake for more than a half an hour during the night trying to sleep and you can't, or you wake up a half an hour before you want to and can't get back to sleep for that last time. So this 30 minutes, at least three nights a week. And it's been going on for at least three months, you should probably see a doctor about insomnia. So that 3030 minutes, at least three nights a week. So and I should also mention, treatments for insomnia are not just medication. So a lot of people don't like taking medication because it makes you drowsy and groggy and kind of other risks like falls and addictions and things like that. But actually what a lot of people don't realize is the most recommended treatment for insomnia, actually is not medications, even though that's what most people get. It just turns out that a lot of doctors don't actually know what the actual guidelines even say. So that actually the most effective treatment for insomnia is actually a behavioral therapy. It's a training protocol called cbti. It stands for cognitive behavior therapy for insomnia. But essentially what it is, is it really teaches your brain to sleep. Because what a lot of people with insomnia have is, no matter what the cause was, the insomnia takes on a life of its own, where you have what's called a conditioned arousal where, where your brain has a really hard time detaching, or when you wake up during the night It has a hard time getting back down to sleep. And what actually happens is you accidentally train your brain to do that by being awake in bed and all these things that happen. And so it cbti does it reprograms you to be able to fall asleep in bed without medication, and actually for decades. It beats out any medication that's been on the market, it's as good or better. That's why most medical organizations recommend it. It's just a lot of people don't know about it, because there's still not a ton of people who are experts at it. But if people were going to search about, and I can give you some links of some directories and stuff, when people do it, it's actually a good non medication, much more natural approach, that actually it has better scientific evidence than any other medication. So it's a good thing. So anyway, so that's insomnia. For people who have some insomnia problems, but don't maybe meet criteria for the disorder, there are a lot of things you can do. The main things I would say is actually give budget time to wind down at night, plan on when you're going to go to bed. And so plan when you're going to put things down so that you don't get into bed and you haven't given yourself time to slow down because you're going to take it anyway in bed. Number two, if you can't sleep, get up and get out of bed. It looks like one of the main things that turns a short term insomnia into a long term insomnia is that people stay in bed awake, tossing and turning. And that's what is one of the things that causes that programming of the brain to be awake in bed. So if you're in bed for 2030 minutes, you can't sleep, get up and take a break, don't just sit there in agony and get up, distract yourself for a little bit, do something else, then get back to bed, you want to minimize your time awake in bed, that the bed actually can trigger a sleep response because you're the bed equal sleep. So if you do those things, that will help set you up for fixing minor sleep problems. So there's other things we can talk about later. So that's insomnia. For sleep deprivation, it's a little harder because remember, most people who are sleep deprived don't know it, or they don't know how sleep deprived they are. So here's a few signs that you might be sleep deprived. Number one, if you fall asleep within like five minutes of your head hitting the pillow, if you're if your head hits the pillow and you're out, that means you're probably too starved for sleep. So it's like, if I put a plate of food in front of you, and you finish all that food in 30 seconds, you were too hungry. So you probably should have eaten a little bit ago, you're too starving. So if you're falling asleep too fast, that's a sign you might be sleep deprived.

Probably the most obvious sign of sleep deprivation, though, is difficulty staying awake during the day. If you have trouble keeping your eyes open for significant amounts of time during the day, if every time you sit down and put on the TV, you fall asleep. If you're even falling asleep, at times when you should be staying awake, like at a meeting or something like that. That's a sign that you're starved for sleep and your body is trying to take it whenever it can. Either. That means you're sleep deprived, in that you're not getting enough. Or it means there's something in the way as keeping your sleep shallow, something like an untreated Sleep Disorder like sleep apnea, or noise, or some medical issue that keeps your sleep shallow at night. If you're having trouble staying awake during the day, that's not normal. It's okay to get a little sleepy in the afternoon. But you shouldn't have an issue keeping your eyes open on a regular basis. Other signs that you're sleep deprived, would be actually in your decision making. If you have a hard time making healthy choices, that's actually a sign of sleep deprivation. So when people are sleep deprived, they start gravitating toward more unhealthy food, because they're craving energy. They start not being able to have the energy to like, get physical activity or make other healthy choices because they're just sluggish. But they don't quite realize that that's what's going on. So those are some signs you might not might be sleep deprived. Also, if you're getting less than six hours, on average at night, that's probably not enough. six to seven is sort of a gray zone, where some people are probably fine. Some for some people, that's not enough. As long as you're getting at least seven hours, you're probably okay.

yishan xu  18:54  

I see. I totally feel what you just mentioned. I think if I have to work more and sleep less, I tend to crave a lot of sugar, I drink Coke, I think caffeine can help me. So I end up drinking more coffee like from one cup a day, two cup a day, and just use all kinds of ways just without even realizing it just mess up my whole system.

Dr. Grandner  19:21  

Yeah, coffee can be great caffeine is actually can be very useful for maintaining alertness, and it peaks after about 30 minutes. But then it can have effects on alertness for four to six hours, which is why some people have trouble falling asleep with it. Some people are very sensitive and even 10 hours it can sort of keep you up. But that could be a good thing if you're trying to sort of counteract some of the fatigue. The problem with caffeine though, is it'll increase focus and attention and decrease fatigue, but it won't necessarily improve thinking and strategic thinking and decision making. So just be aware of that where and productivity. So we found that the gap didn't fix the productivity. You see this in athletes to athletes who have caffeine are stronger and faster. But if they're sleep deprived, they still make the same mistakes. So like, for example, is a great study in tennis players, sleep deprived tennis players. Without caffeine, their surfing accuracy decreased by like 50%. with caffeine, it was only 30%. But it's still 30%. Worse, it helped a little bit. But it didn't help all the way not even halfway. And that's what we see a lot with caffeine. It'll help keep you awake. And if that's what's important, great. It'll help reduce fatigue and ability to help you focus. But you don't make the best decisions and your performance isn't totally rescued.

yishan xu  20:42  

Hmm. So depends on what kind of job we do, what kind of things we have to do, how are we going to use our brain to think to plan to organize then we should really thinking about what to do sleep more, use caffeine, or better how to arrange it.

Dr. Grandner  20:59  

Or even plan a nap. You know, or even a short nap. A short nap actually can sometimes do even more than caffeine.

yishan xu  21:06  

Ah, I do hear the word power nap. Even a short one can be powerful, huh?

Dr. Grandner  21:14  

Yeah. So the way sleep works is we start out awake, and then we drop down into deeper stages of sleep. And then we come back up into light sleep. A power nap means you nap. But you wake up before you get into deep sleep. Usually, this can be 2030 minutes. But that is enough to get some of the benefits of sleep. Actually, if you nap for too long, and you wake up from that deeper sleep, you feel worse. So actually, sometimes the shorter naps are better. And to be totally honest, they work the best when you're not already sleep deprived. So if you're if you're maybe a little tired, but not not like chronically sleep deprived, a power nap can actually be a super effective strategy for improving focus, improving learning and memory and having energy for the rest of the day and not feeling sleepy. If you're very sleep deprived, you might drop down into that deep sleep faster, because you're hungry for it. And then sometimes you wake up and thinking that oh, I shouldn't have nap because I feel worse. Because that means you are actually you actually might have been a little too sleep deprived for that nap. You know, it's like, it's like, if you're if you're really starving, having a small snack sometimes makes you feel worse.

yishan xu  22:23  

Right.

Dr. Grandner  22:24  

But if you're not starving, sometimes a small snack can help keep you going through the day.

yishan xu  22:28  

Definitely. I like the analogy between food and sleep. Yeah, awesome. So you mentioned a little bit what we should do. So just overall, I know you have to go soon so any last wisdoms about what people what our audience can do to help themselves, after they have some awareness where their sleep is what they can do to make them better.

Dr. Grandner  22:55  

Yeah, so first thing, I would challenge people to think of sleep this way. What if I told you, I had an exercise routine, that this exercise routine could not only improve your physical performance, but your mental performance as well. it'll improve your mental health. It could improve your weight regulation and your diet, it could improve your relationships and interpersonal relations, and it'll improve your health overall. But more importantly, it'll help you feel better. It'll help you perform better, would you do it? And what if I told you, you don't even have to do it every day, just do it when you can. And you can do it for free every night. And it doesn't take too much extra time it takes 30 to 60 minutes, depending on how much time you have. Would you do it. And the thing is, with all the benefits that people get from it, people spend way more money on much fewer benefits. But the truth is, we have the ability to do this stuff. It's a natural performance enhancer. We just take it for granted. So the first thing I would say I was I would challenge people to think of sleep not as an inconvenience, but as a performance enhancer at their disposal for free. That can also not only man it helped manage their mental and physical functioning, but also can help regulate their immune system and weight and food cravings. The next thing I would say is actually maybe setting a good time in the morning will help because if you get bright light and movements in the morning, it helps set your circadian rhythms for the whole day can also improve mood and improve energy levels through the whole day. Two don't feel asleep if you get some bright lights, especially outdoor light, especially relatively early in the morning. That can help set your clock for the day. And then I mentioned before that you should plan time to wind down budget for it. Make that part of your plan so that you're ready for sleep when when it's time so that when you get into bed, your body and your mind are ready and you can fall asleep easier. And then the final thing is don't spend more than 2030 minutes in bed awake at any time. Just get up eat If it's just for five minutes, most people might need 30 to 60 minutes up before they try again. And even if you sleep less tonight, what it's doing is it's protecting your sleep for the future. And the final thing I would say is, one thing we learned from sleep deprivation studies is that if you've slept pretty good for a week or two, and you have one or two nights of bad sleep, it actually doesn't impair you very much. You have a good buffer. So banking sleep and getting a good buffer of sleep is a great way to protect you from from the stress of sleep deprivation. I mean, this is what I tell the athletes too, is if you've got a competition, and you can't sleep the night before, that's okay. Just get good sleep for the week before. And even if you feel a little more tired The next day, your performance will probably be fine.

yishan xu  25:45  

That's awesome. Thank you very much Dr. Grandner this is awesome information.

Dr. Grandner  25:52  

Thank you. Thank you so much.

yishan xu  25:54  

Awesome conversation with Dr. Grandner. What do you think about it? The two key points I gonna carry away myself is sleep is investment. It's not a waste of time. And it's certainly not a burden. Second thing I take away is, if I won't decide when I should go to bed, I really need to think about how functional I want to be the next day. If there are lots waiting for me, and do you use my brain a lot; then I will make sure I sleep early and drop everything I need to do at late night. Shut off my brain, stop working, just go to bed. So what is your takeaway? Please feel free to comment in the comment area or email me at yishan@mindbodygarden.com to let me know how you think, and what you learned from this conversation. If you want to learn more about sleep science, sleep knowledge, and know how to use those to guide your own behaviors, you can read Dr. Grandner new book "Sleep and Health". I will put all the information to the show notes and you can find the show notes on our website at deepintosleep.co. On our website, we have a tab called resource in there you will be able to find the literal he mentioned, to find Certified Behavioral Sleep Medicine Psychologists to help you with your insomnia problems. And of course, you will find my name on those directories also. And if you need help, I also deliver CBT-I (CBT for Insomnia) treatment, both in group format and individual format; both in Mandarin and English. If you need any help, please feel free to let me know and you can find my information on the website deepintosleep.co. At the end, I just want to say thank you to you all for listening. Your support it's great motivation for me to continuously generate more contents, more great conversations on this podcast. I have been doing this for about a year, and we have more than 10,000 downloads already and over 55 episodes. I am so grateful to have you all. If you enjoy our show please leave us a review or comment on Apple Podcast or any other podcast platforms you are listening from. Thank you so much for being here with me. I will see you next week.

Unknown Speaker  28:45  

Sleep as an individual saying we all sleep differently. And there are so much we can do to improve sleep quality. Keep hope and carry on. This podcast is for general informational purposes only and does not include the practice of medicine or other health professional services. The usage of the information we share is that the listeners own risk. And our content does not intend to be a substitute for any medical and professional services, diagnoses and treatment. please seek professional health services as needed.

Dr. Yishan Xuinsomnia, sleep deprivation, sleep loss, power nap, caffeine, sleep, health, productivity, improve productivity, CBT-IComment