Michigan Answers: Questions About Sleep

Sleep quality, or lack of it, can affect how we feel, how we act, our performance at work, our relationships. The American Sleep Association has found that more than 37% of Americans reported unintentionally falling asleep during the day at least once in the preceding month.

That’s a lot of tired people.

In this episode, clinical sleep psychologist Deirdre Conroy, Ph.D. joins us to answer the most commonly searched questions on the internet about sleep, including:

  • What are the most common types of sleep disorders?
  • Is restless leg syndrome a sleep disorder?
  • Is insomnia curable?
  • Do some medical conditions have a link to sleep disorders?
  • What effects can sleep have on mental health?
  • When should you see a specialist about sleep difficulties?
  • What are your tips for people with difficulty sleeping?
  • Is it “normal” to get 8 hours of uninterrupted sleep?
  • Should you expect to get less sleep as you age?
  • What do people need to know about TV and phones and their impact on sleep?
  • Is melatonin safe and effective as a sleep aid?
  • Is there a link between marijuana and sleep difficulties?

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Episode Transcript

Dr. Preeti Malani (00:02):
Sleep is a big deal. Sleep quality, or lack of it, can affect how we feel, how we act, our performance at work, our relationships. The effects are wide-reaching, personally, and as a society, the public health consequences of sleep disorders are huge. The American Sleep Association has found that more than 37% of Americans reported unintentionally falling asleep during the day at least once in the preceding month, that's a lot of tired people. So let's talk about sleep. I'm not going to take this one on myself though. Our guest today is Dr. Deirdre Conroy. Dr. Conroy is a clinical psychologist specializing in sleep medicine, she's also the clinical director of the Behavioral Sleep Medicine Clinic at University of Michigan Health. If you don't have questions about your own sleep, chances are there is someone in your life who does, so no sleeping through this one. I'm Dr. Dr. Preeti Malani, and thanks for joining us on the Michigan Answers Podcast.Hi Dr. Conroy, thanks for joining us today.     

Dr. Deirdre Conroy (01:06):
Thank you so much for having me, it's a pleasure to be here.

Dr. Preeti Malani (01:09):
So our team has scoured the internet and pulled together a list of the most searched questions about sleep. I'm going to walk you through a handful of the most common ones, and well, we hope you're going to have all the answers. Let's get started. What are the most common types of sleep disorders?

Dr. Deirdre Conroy (01:25):
So the most common sleep disorders will probably be insomnia, there's also obstructive sleep apnea or the other types of sleep apnea that usually are the most commonly diagnosed, commonly reported disorders in people struggling with sleep.

Dr. Preeti Malani (01:41):
What about restless leg syndrome? We hear a lot about that.

Dr. Deirdre Conroy (01:43):
Yeah, restless leg syndrome is also common. It is characterized by an urge to move the legs that typically occurs only in the evening. And it's actually considered a sleep disorder because it can impact one's ability to fall asleep.

Dr. Preeti Malani (02:00):
Let's talk more about insomnia. How can you manage insomnia? And is it curable?

Dr. Deirdre Conroy (02:04):
So insomnia, first I'll define how we diagnose insomnia. So it is a complaint of difficulty falling asleep, staying asleep, waking up too early. And that has some kind of implication on your functioning the next day. So whether it contributes to daytime tiredness, difficulty concentrating, mood problems, and so on. And typically this disturbance happens at least three nights a week for a period of three months to be considered chronic insomnia.

Dr. Preeti Malani (02:34):
Is it curable?

Dr. Deirdre Conroy (02:35):
So curable is a big word, of course, in the medical field, but there are certainly interventions and changes in your habit that can really improve sleep. So I think about this in two ways, assisting with the difficulty sleeping every once in a while can be helped with a term called sleep hygiene. So things like avoiding caffeine right before bed and alcohol, and other habits that I can talk more about later. But in terms of curative, really interventions like cognitive behavioral therapy for insomnia, a multi-session, ongoing approach to restructuring one's thoughts and habits around sleep, has the most evidence to support a reduction in insomnia over time. And in fact, a recent research study found that even after 10 years, people were sleeping better after undergoing this particular type of intervention.

Dr. Preeti Malani (03:32):
Are there some medical conditions that have a link to sleep, like heart disease, for example?

Dr. Deirdre Conroy (03:36):
Well, any kind of sleep apnea, so for example, obstructive sleep apnea, which is a sleep disorder characterized by difficulty breathing in sleep. We can pause our breathing, sometimes this is characterized by snoring, loud snoring, bed partners can observe either gasping or choking or pauses in breathing. And that can wake us up several times a night, affect our oxygen saturation through the night, and contribute to next-day functioning difficulties. And obstructive sleep apnea that goes untreated has found to be linked to cardiovascular and cerebrovascular complications.

Dr. Preeti Malani (04:13):
What effect can sleep have on your mental health?

Dr. Deirdre Conroy (04:16):
So this is a huge question that lots of people are interested in, both clinically and in the research realm. And I like to think about this as a bidirectional relationship. Certainly we've all experienced, or most of us, the difficulty sleeping one night and having it affect our mood the next day. So often irritable or depressed, or just feeling more anxious than usual. But there have been studies that also show that having insomnia can lead to difficulties with mood, and mood difficulties can contribute to insomnia. And sometimes we don't know which one is starting first. And in some cases, the difficulty sleeping early in life can contribute both longitudinally, and of course, next-day functioning difficulties as well.

Dr. Preeti Malani (05:05):
When does having trouble sleeping at night turn into something that someone should talk to a health professional about?

Dr. Deirdre Conroy (05:13):
There is a degree of having a bad night every once in a while that is completely normal, we've all experienced when we have something to do the next day or a flight to catch. But if this becomes more frequent and particularly interfering with your functioning during the day, this is a sign that you should probably speak to your doctor about it. So for example, if you're falling asleep during the day and you don't mean to, or you're feeling more fatigued or tired than usual, you may want further testing from a sleep specialist.

Dr. Preeti Malani (05:47):
What are your tips for the average adult who maybe doesn't have a diagnosed sleep disorder, but still has trouble sleeping from time to time?

Dr. Deirdre Conroy (05:54):
My tips would really relate to what are your habits? What are your habits that you keep most of the time? So in order to decrease the likelihood of having a poor night's sleep, it's usually the routine that has a lot to do with sleep. So what I mean by routine is when do you get up every day? Is it different on the weekends? Sometimes people will sleep later on the weekends to catch up for sleep loss. So I might keep them on a regular sleep break schedule, or just knowing how you respond to certain types of activation, like whether that's TV or movies or social media. So many people have told me, especially in the last few years, how uncomfortable and anxiety provoking watching the news has been. And so learning more about how news et cetera might affect your thinking, you might want to avoid watching the news or engaging in social media before bed or during the night.

Dr. Preeti Malani (06:57):
Something that I'm just reflecting on is that we all have some difficulty sleeping from time to time. And there's this myth that maybe you just can hit the pillow and sleep beautifully uninterrupted for eight hours and wake up great. And that's not true for most of us.

Dr. Deirdre Conroy (07:14):
I would agree with that. And so often in my clinic, so most of my patients struggle with insomnia, and they say to me, "I would like eight hours of sleep every night, and I would like to not wake up. And I would like to feel amazing the next day and do jumping jacks." And while we all want to be very productive and we all want a solid restful night's sleep, it is normal to wake up a couple of times during the night, it's normal for it to take about a half hour to fall asleep, you might experience an awakening during the night, during which you're awake for about a half hour. And if you feel okay the next day, that's just all part of the human functioning of sleeping. It actually shouldn't be an experience where your head hits the pillow and you're out immediately. That, in fact, may indicate that you have been struggling with sleep, either with quality or quantity, and that on its own may reflect more of a disorder than what's normal.

Dr. Preeti Malani (08:15):
You mentioned devices and sleep, how about phones?

Dr. Deirdre Conroy (08:19):
So many of my patients keep their phone next to them while they sleep. And if they wake up during the night, might turn to the phone to look at it to pass the time while awake. And this is problematic in a couple of ways. One, because there is light that is emitted from the phone, particularly blue light, we know affects the body clock, the circadian pacemaker. So you might be affecting your melatonin rhythm across the night, which it can affect sleep. But also the engagement with such stimulating information that's available throughout the night is not conducive to falling back to sleep. So I usually like to talk to my patients about setting limits with the access to their phone during the night.

Dr. Preeti Malani (09:01):
Does your ability to sleep well change as you get older?

Dr. Deirdre Conroy (09:04):
Sleep definitely changes as we get older. If you look at to the quantity and quality of sleep across the lifespan, of course, babies sleep 16 hours, then when we become children, we're sleeping 8 to 12 hours, and then the number of hours tends to decrease across the lifespan. So it might be decreasing to 6 hours beyond age 60 or 70. The reasons for that are multifactorial. We also experience more medical issues as we get older, so that could perhaps influence disruption of sleep. So greater number of awakenings during the night or medications that affect sleep, nocturia or having to use the restroom frequently during the night can all increase as we get older, in addition to the incidents of sleep apnea, as we get older, can all interfere with the quality of sleep. So we do definitely find changes in sleep as we age.

Dr. Deirdre Conroy (10:03):
And this is also something I like to educate my patients about because so often I do speak with my older patients about what should sleep look like for you at your age, and oftentimes, the request or the goal really is, "I'd like to sleep the same way that I did when I was 25." And unfortunately, that's very difficult to do because the brain does change as we age.

Dr. Preeti Malani (10:25):
Dr. Conroy, you focus a lot on adolescents and sleep.

Dr. Deirdre Conroy (10:29):
Yeah, certainly I've done some research on adolescents, particularly in depression and adolescents and what types of sleep interventions we can try out in adolescents.

Dr. Preeti Malani (10:40):
What about over-the-counter sleep aids?

Dr. Deirdre Conroy (10:42):
So over-the-counter sleep aids, a lot of times these days, many of us use melatonin, or you may also hear Nyquil or Zzzquil. In general, over-the-counter sleep aids don't have a lot of efficacy over long term. They also tend to last in the body for a while, meaning the effects could still be present the next day when waking up, you might feel a little bit more groggy. Melatonin is unlike those others. I mentioned it's a naturally occurring hormone, but can be purchased over the counter. So exogenous melatonin versus endogenous, meaning in our body. So melatonin, in pill form, is being used quite often, especially in the adolescent population. And the one distinction I like to make with melatonin is that it can actually be quite effective in very low doses for certain types of sleep disorders.

Dr. Deirdre Conroy (11:37):
So for example, if I am a night owl, and it's taking me hours and hours to fall asleep, and I sleep from say 3:00 AM to 12:00 PM, and I really can't uphold that schedule more, I might use a little bit of melatonin early in the evening to shift the biological clock to an earlier time. So melatonin can be very helpful for body clock problems, but interestingly, the data to support melatonin as a hypnotic or as a sleep aid to help us fall asleep is actually not as impressive, given how many people are taking the medication. But it certainly is helpful anecdotally. I have many patients that report taking melatonin at bedtime and finding it to be helpful. We usually don't recommend more than 10 milligrams at night. So really understanding how much your patient is taking can be helpful in your assessment and diagnosis.

Dr. Preeti Malani (12:34):
So occasional use is not unreasonable.

Dr. Deirdre Conroy (12:37):
Occasional use is not unreasonable for something like that.

Dr. Preeti Malani (12:40):
What's an area of sleep disorder research that is most exciting to you right now?

Dr. Deirdre Conroy (12:44):
The area that's most exciting to me has been how the use of cannabis or marijuana is affecting sleep, and vice versa how poor sleep can affect marijuana use. This is a topic that's been evolving over the years, and unfortunately, the science is slower than the availability of the products. And so I think more research on types of marijuana or how does sleep interact with the use of marijuana is going to be interesting.

Dr. Deirdre Conroy (13:16):
So for example, one of the projects that we're working on in the Department of Psychiatry is whether sleep intervention with cognitive behavioral therapy for insomnia changes the use of cannabis. So we have participants who recreationally using cannabis. It's not an intervention to reduce the marijuana per se, but can better sleep lead to less use of marijuana?

Dr. Preeti Malani (13:42):
Dr. Deirdre Conroy, thank you for sharing your time and expertise with us today, and thank you to our listeners for tuning into this week's episode of Michigan Answers. If you enjoyed today's episode, please subscribe wherever you get your podcasts. We are unpacking some of the most searched for health topics on the internet. And if you're interested in learning more about how Michigan Medicine is improving lives and advancing health, you can visit michigananswers.com. See you next week.

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