We spend one third of our lifetimes sleeping, yet often relegate the importance of rest to the backburner. These sleep medicine specialists and holistic practitioners aim to turn the spotlight on our non-waking hours, reminding us how sleep is not only essential to maintaining health and living longer, but is also a manner of rebirth as we start anew each morning.

SRQ: What are some of the most common problems you see in terms of sleep? Dr. Matthew Edlund (Director, Center for Circadian Medicine): Sleep is a big part of public health. The real question is: What is sleep for? My belief is that it is to rebuild the body. We have this idea that health likens us to machines. Illness is when we break down. What really happens is we fail to rebuild and that’s the basis of illness. And why is sleep critical to that? A large part of human regeneration takes place in sleep. Sleep is like food. If you don’t sleep, you don’t live. Very special things happen: the brain reorganizes, memory and cognition—everything gets redone and replaced. The beauty is when you wake up each morning you’re partially reborn and remade. And one of the big problems is, as times have changed, as we’ve moved to different kinds of social media and different ways of life, a lot of people have forgotten how to sleep. They don’t know what it is, they don’t know what it’s for. It’s a waste of time—it’s a thing away from what they want to do, rather than something critical to remaking, renewing and rebuilding our bodies. Dr. Steven Scheer (Sleep Medicine Specialist, Optimal Sleep Health): Most primary physicians, most specialists, know woefully little about sleep. Because of the Internet, widespread media reports and also a few notable deaths related to sleep, the consciousness was raised in the world and now we have been able to see a lot more people coming to us because primary physicians, neurologists, cardiologists and others recognize that they don’t know so much and they’re tired of just prescribing sleeping pills. Dr. Glenn Adams (Pulmonologist, Sleep Medicine Specialist, Sarasota Memorial Hospital): I lecture to the Florida State University medical students and I’m given one afternoon to teach what we spend one third of our lives doing. You can’t diagnose what you don’t know. We’re limited to the time we have: if a doctor has three articles in front of them—one on pneumonia, one on heart attacks and one on sleep apnea—chances are they’re not going to read the one on sleep apnea. The unfortunate thing about that is they see more people with sleep apnea than they’re going to see with pneumonia. Stacy Koski (Holistic Health Coach, Registered Nurse): I’m a registered nurse and have a degree in holistic nutrition—practicing in both spaces is interesting, especially in a community where people are getting older. People don’t realize how much food has an impact on their ability to sleep and how the quality of our food has deteriorated. There are so many stimulants, especially sugar hidden in food.

It sounds like sleep issues could be the underlying problem for many different disorders. How do you go about diagnosing a sleep problem versus another medical problem? Edlund: Insomnia is the chronic national complaint. Ten percent of people in the country supposedly have it badly but it’s more like one third. In many cases, they may not even know what it feels like to be truly rested. It’s also about what people are doing to rest properly, to rebuild themselves. How are they eating and moving? You can show, for a lot of people who are insomniacs, if they take a morning walk and they get sunlight, in many cases they will sleep better. Their body clocks have been reset; they grow new brain cells. Physical activity is the one true way you can prove in humans that you can grow new brain cells in memory areas. You’ll find a lot of the things that impact your life will impact your sleep, not just because it’s a third of your life but because it’s this critical part of your life. Scheer: Before the invention of the light bulb, the average American slept over nine hours a day in a 24-hour period. The present-day average for working Americans is somewhere between six and six-and-three-quarters hours of the 24-hour period. The introduction of electricity and then the evolution to the Internet and then Netflix and emails, et cetera—that’s all led to a total change. As Dr. Edlund alluded to, people are now almost annoyed that they have to go to sleep. There’s so much to do that stimulates you that we’re chronically under-slept. Adams: When you’re a high school kid and still need nine hours of sleep and you’re going to sleep and getting eight, seven or six, it results in Insufficient Sleep Syndrome, which is, along with insomnia, probably the most common issue that we all face. It’s just not getting enough sleep at night. And why? As Dr. Scheer said: we’re on the Internet. When you’re on the Internet at night—you want that bright light in the morning, you don’t want to be sitting 10 inches in front of a bright light in the evening where it stimulates you. Light helps you wake up, you don’t want to be woken up and have your brain more alerted when you’re trying to wind it down. Scheer: Unfortunately, our high school administrators and teachers are totally unaware of the biological change in puberty where children are undergoing changes in their biological clocks where they actually would prefer to go to bed later, not because they want to be on the Internet necessarily but because they can’t go to sleep earlier. The response of the schools is not to make the school time later for high school students—which would also lessen car accidents on the way to work, which they found in studies of accidents where school systems made a change in delaying start time for high school students—but the average teachers and principals respond by hauling in the parents and saying they’re not being strict enough with their children. Edlund: They also don’t know how aging changes sleep. Kids need nine-and-a-half hours to score best on tests, where instead they get six to seven. They want to go to bed at midnight or 1 o’clock, but if you’re getting up for the school bus at 6:30am—what are you actually going to get? Five or six hours of sleep. The end result: not just the inability to think, but changes in terms of colds, brain function, overall productivity across the board. Then you come to a town like this, where the population is older—totally different sleep needs. The body clock changes generally over a lifetime to about 90 minutes earlier. Now you’re starting to see sleep schools. I set up Sleep University a little while ago because people don’t know how to sleep. The real trick is: how do you rest people so they are going to be healthier, most effective and most productive. Overall consciousness changes throughout the 24-hour period. For most people, early evening is when they are most sharp. This is when you hit Olympic records—people are faster, people are more accurate around 5pm or 6pm. But we have a 24/7 economic system—people are working around the world, so we’re running into problems now with CEOs that don’t know how to sleep anymore. They’re flying from country to country; they’re taking calls all through the night. We’re turning large portions of the population into shift workers. Ashley Stewart (Co-Founder, Bliss Entourage): When you don’t get enough sleep, it messes up your hormones—sleep is your body’s time to come to a space of homeostasis from a day of working hard and having high cortisone levels and having lots of hormones run through the body. When you haven’t gotten enough sleep, the next day you might find that you are hungry all day, you can’t stop eating because those hormone levels that tell you whether or not you’re full haven’t been replenished. That hunger hormone level is still elevated—meaning people can gain weight. If your cortisol levels haven’t been able to lower, your body is still feeling stressed—it causes irritation. It causes anger, sadness and depression. People might be having anger issues, frustration or just feel like they’re in a funk from something in life that happened. And it could be completely related to how much sleep they get at night. If people were told they could gain weight if you don’t get enough sleep, especially in our current culture where weight gain is constantly being talked about, where fitness and health and image are constantly being praised—if you’re trying to sell sleep, start talking about how it can affect your weight and your mood. Edlund: And your appearance. When you look at people who have sleep deprivation versus their normal sleep, they look a whole lot worse. With sleep medicine, there are three things: people who sleep too much, people who sleep too little and people who do weird things in their sleep. When you’ve got a medical problem, it very often leads to problems with sleep. If you’ve got a sleep problem, it very often leads to a medical problem. In other words, when people have insomnia it leads to more heart disease, more stroke. When people are shift workers, the World Health Organization is thinking this is a potential carcinogen. The real trick is putting them together. If you look at what makes people survive longer (which is a big issue in a town like this), you look at data from the Swedes—lifestyle adds six or seven years at age 65. Medical care: a few months. At 85, lifestyle adds four years. Medical care: zero. What you do is what you become: how you eat, how you move, how you rest, how you socialize are critical factors in overall health.

Is there a link between sleep disorders and diseases like Alzheimer’s and Parkinson’s? Scheer: Definitely. Koski: When our body is able to rest and repair, it helps decrease inflammation. Inflammation has been linked to many diseases—heart disease, diabetes and Alzheimer’s. Pretty much everything we do on a daily basis causes inflammation, so many things we do irritate our systems. Even if we are super athletic and eat super clean, working out creates inflammation no matter what. By having time to sleep and restore the body, it decreases a lot of these disease processes that may present. Edlund: There is some data that some people, especially women, who have severe sleep apnea have more Alzheimer’s disease. But there are a lot of arguments. For example, in Quebec there was a big study that argues that sleeping pills lead to more Alzheimer’s disease. The body is an information system; everything affects everything else. Adams: It’s one thing to have a patient come into your office because they snore, they’re tired all the time, you diagnose and treat their sleep apnea and a good percentage of them will come back and say they feel great, thank you very much. Then there are some people that say, “I feel better but I’m not where I need to be—I’m doing everything you say I should do.” And then you have to look deeper. Not all sleepiness is due to a sleep disorder. There’s a lot of medical conditions: you need to look at things like B12 levels, Vitamin D levels, low iron levels, anemia, low testosterone in men, you have to look at the medications you are taking—those medications are going to affect sleep, let alone a lot of the psych meds that people take. What’s really interesting is how long people have had sleepiness or fatigue, and have not had a clue they have it. Scheer: I’m amazed at the number of people who come in and have taken a very long time to get to a sleep specialist. If you focus on something like where your heart or your brain is the issue, they’re going to go to the doctor right away. But when it comes to a referral to a sleep specialist, they sometimes give it short shrift. They pass it off as not that important. There’s kind of a scuttlebutt out there amongst people that if you go to a sleep specialist you’re going to be in a sleep lab, and you’re going to be having to sleep in front of somebody, there’s going to be a video camera taping you, you’re going to have 45 electrodes hooked up to you—how can you possibly sleep in an environment like that? What’s the point? Well, now there are apps you can use on your phone on your bed or in the room called an Actigraph that’s recording if there’s movement or not and translating that into what stage of sleep they were in. You have to sell patients a lot of the time on the importance of having their sleep evaluated. I’m also fascinated here—I didn’t see as much up north—older people who are diagnosed with narcolepsy and have lived all their lives excessively sleepy, thinking it was just their norm and not realizing that there was something that could be done about it. Adams: Right, and they’ve never seen anyone about it because years ago there wasn’t such a thing—when you were 18 years old and now you’re 70—as sleep labs and stuff. No one knew about narcolepsy until the mid-70s. Koski: Do you think that is because we are becoming more focused on holistic health? Looking at the person as a whole? Edlund: We’re just more interested in things like productivity and alertness than people used to be. Adams: But don’t you think that people, at least in Sarasota, are becoming more attuned to their bodies and paying a little more attention compared to what we did when we were kids? Edlund: It’s the gradual dawning on people that lifestyle is the big issue in terms of survival. So yeah, they’re going to pay a lot more attention to sleep. But they also want to pay attention to feeling whole. Feeling alert and feeling alive. That’s part of where sleep comes in. In many cases, people don’t know what it is to feel really alert. Adams: We will see people for snoring, they’re asymptomatic—they say, “I snore, my bed partner won’t sleep with me, this is terrible. I don’t think I have a problem and I don’t really want to be here.” So you study these asymptomatic patients who only snore and you find they have a disorder like sleep apnea and you treat them and they come back to you, not happy that they’re on whatever kind of treatment, and you ask them if they are snoring. And they say the snoring is gone. And then I’ll always say, “How do you sleep? How do you feel?” And not uncommonly people say, “I feel better.” And I say, “Wait a minute what do you mean? You told me you felt good before.” They think they did feel good and that they had been normal for years. You fix the sleep disorder and all of a sudden what you thought was normal really wasn’t and now you can tell the difference. Koski: That’s because we’re thinking and becoming more conscious—people naturally have a desire to better. Once you start feeling better, I see it in nutrition, they think they feel good and then they start feeling better and then they’re like, oh you can feel great. Adams: You see that a lot, especially with Millennials. You can talk about things like Fitbits—there is a host of different kind of devices that we can wear to try to gauge how well we’re doing when we sleep at night. We assume we put our head on the pillow, count a few sheep and we fall asleep and we sleep ok. But now people are becoming more in tune with this—the problem is that technology isn’t quite there yet and we’re really not able to tell how much better we’re really sleeping. Scheer: Sometimes people come back and say, “I don’t know if I’m any better.” We all have these surveys we use in our offices that people fill out before they come in—one is the Epworth Sleepiness Scale, which is an internationally used tool that subjectively measures how sleepy are you in eight scenarios. When they come back two months later after they’ve, say, been on therapy for sleep apnea, if they say something like, “I’m doing what you told me to do and I’m sleeping like I’m supposed to. I’m using the machine but I don’t know that I’m any better.” So I say to them, “Well, how many times are you going to the bathroom at night?” And they realize they’re only going once or maybe not at all, whereas according to the survey they were going three times a night before. Then they realize that was related to having a breathing problem. Before when they weren’t breathing well, they were getting up so often to urinate. Edlund: Why do people have that misperception? Scheer: Because for them it’s a hassle to use equipment. There’s a kind of a feeling like they’d rather not have to do this, and they try to come up with a reason why they don’t have to keep doing it. I know it’s better for the heart and the brain, and I tell them that, but that’s something that’s intangible. It’s a heart attack I might have 10 years from now, or a stroke five years from now but that’s pretty nebulous. But here and now, I don’t get up to pee in the middle of the night, I’m not sweating, my wife says I don’t snore. Reluctantly, the person comes along—sometimes you have to drag them in to the acceptance. Edlund: We think sleep and waking are like a light switch. We call it the “lie down and die” model. Which is rubbish. There’s this huge misperception in terms of when people are awake and when they are asleep, which is a real problem in terms of accidents and falls. People often don’t know when they are asleep and when they’re awake in part because their sleep isn’t deep enough, isn’t strong enough. We have microsleeps all the time—especially on the highway. Scheer: Which makes even more frightening the statistic that the National Sleep Foundation collects when they ask 1,000 random households across the US: who has sleep problems in the family? Eighteen to 20 percent of people will say that somebody in that household fell asleep while driving that year. And that’s the people who knew and reported it. It must be much higher than that. Edlund: Microsleeps are defined usually as being between three and 15 seconds—three seconds on a highway: that can be it. Adams: Stanford did a study where they took sleepy people and they put a light right in front of their faces—when the light goes on you hit a button. Shine the light, hit the button, shine the light, hit the button, shine it, no button. When asked why they didn’t hit the button, they had no clue the light had been shined because they had a microsleep. Between that and sleep deprivation we have it’s not that far-fetched that when you look at things like the major accidents that have occurred in our day—Three Mile Island, Chernobyl, Exxon Valdez—they all occurred during the night shift. The Exxon Valdez, the guy was standing up driving the boat but he was asleep. Besides the fact that these accidents happened on the third shift, they were middle of the night, sleep-deprived individuals who were making mistakes and thought they were awake. Edlund: Performance changes as we move through the 24-hour clock. What’s really wacko is that people don’t understand the effects of drugs—alcohol, for example, will have two- or three-fold the effect after midnight as it will at 6pm. People will go out and drive after one drink and it was at 1am and have no idea that what they’ve basically done to themselves is the equivalent of three or four drinks. Drug metabolism can vary seven- or eight-fold depending on when you take it, how quickly it gets metabolized. Adams: People tend to take their medications in the morning, but we don’t realize that asthma, for example, is typically worse at 4am, acid reflux is typically worse in the evening. Even something as simple as allergic rhinitis or runny nose and stuffy nose is more common in the middle of the night. Those things are interrupting our sleep. The problem is, you’re taking your pill in the morning, whereas if you use something called chronotherapy, you treat the disease when you have the symptoms. When you take your acid reflux medication before supper, if you take your nasal steroids in the evening, you’re treating the disease when you need it most, which is in the middle of the night. There are more heart attacks and more strokes in the middle of the night or first thing in the morning because, again, you have more fluctuations of blood pressure and heart rate when you are in REM sleep. Edlund: Even in terms of lifestyle—the peak time of death in the US is Monday morning. People come in from the weekend, going to bed late, getting up late two days in a row. The period between 9am and 11am on Monday is about five times the death rate from cardiovascular diseases than would otherwise be expected. Everything runs according to time. A lot of people find that if they take a walk at lunchtime, they get sunlight and physical activity, they are far more productive in the afternoon. People get into the hang-up where they have to take a stimulant, then a depressant. It’s an up-down cycle. It goes on forever. It’s a lot easier if you get people to walk or do yoga.

What are some sleep rituals that can influence good sleep? How can you teach yourself to sleep properly? Edlund: You have to expect to rest before you sleep. We are hyper-stimulated with our cell phones with that wonderful blue light keeping us up; we’re getting texts at all hours. A lot of the time, you have to go on an electronic diet. For the hour or hour-and-a-half before you go to sleep, the electronics go off. Generally, what gets people to go to sleep is not necessarily something boring—you read something that takes you far away, rhythmic stuff. I rarely can get people to stay awake if they’re reading The Song of Hiawatha, or about the history of mathematics. Picture books and travel books work—things that prepare you to dream. If you can give people the kind of imagery and thoughts that will give them really pleasant dreams and you do that before they go to sleep, that will often change their dream content. What’s beautiful is the same stuff, the same rituals work when people wake up in the middle of the night. As long as they don’t look at the clock—clock watching is a real disaster. If people look at clocks then their own internal clocks tend to get set and they tend to keep waking at the same time. Adams: What’s happening is when you do that, if you do something exciting or stimulating or watch a good movie or read a good book, the juices are flowing, adrenaline is flowing and adrenaline keeps you awake. When you’re having trouble falling asleep, just do that in your mind: play your last round of golf, go on a trip, go on a favorite vacation and try to relive the vacation in a little bit of detail, put yourself in a different place. Counting sheep doesn’t work—I’m still thinking about the problems of the day as I’m counting. We go to bed and think about what we have to do tomorrow—that’s the only time we have to deal with our demons. We need to take time at 5pm, get home from work, go for a walk and try to sort out your life to some degree. If you could wind down before bedtime, if you have some kind of ritual or if you can go somewhere in your mind and you’ve already dealt with the demons earlier in the day, you might have an easier time going to sleep. Koski: That sounds like meditation too, a way to take yourself out of your mind. You’re quieting your mind whether it’s counting with inhalations and exhalations, because people are chronically hypoxic since they don’t breathe. We only breathe through a portion of our lung space. Concentrating on inhaling for seven counts and holding and exhaling. The thoughts start to slow down and go away. It’s a form of resting before sleeping. Scheer: Dream research is a fascinating side step that has been taken by a lot of people, particularly in psychology and psychiatry, but that’s where the field started—with Freud. It’s very interesting for children; they recommend children who have nightmares and night terrors to draw a picture of the way the dream should end, not the way it has been ending, so that it’s a nice ending. For adults, they recommend writing a screenplay where you take the bad dream you’re having and write it in such a way that it ends well. And then read that screenplay before bedtime. Everyone is fascinated by their dreams. Edlund: Especially people who dream lucidly. There’s all these training schools now that teach people how to get inside their dreams and take control of them. If you think about it, sleep is really different stages of consciousness—wakefulness is when we think we’re alive, but in sleep we’ve got light sleep, deep sleep, REM sleep—they are wholly different biological states of consciousness. The problem is that, with the exception of REM sleep and some aspects of light sleep, we don’t remember it. If we could recall all the things that are going on in our minds, we’d have several different lifetimes. Stewart: If you’re on your electronics, you’re stimulating that alertness in the brain, but also having lights in your room and having a TV in your room, even if they aren’t on everything carries a vibration and frequency. Even when they aren’t on, electronics are still sending out frequencies and vibrations that stimulate your nervous system. I cannot have my cellphone near my head because I can feel the vibrations. Menstrual cycles are affected by lights in the room. Having an environment where you are detoxing from your electronics for at least an hour or hour and a half before bed, meditation—one of the most beneficial types is that breath count. It keeps a fluid amount of oxygen flowing into the body and expands the lungs, taking the nervous system down. This is a reason yoga is so effective for people who have sleep issues. You stretch out your lungs and you keep that rhythmic deep breath with you all night. Koski: And it’s really important for people to also think about what they are eating before they go to sleep. Chocolate has caffeine in it. Eating a stimulating food and going to bed 20 minutes later is going to be problematic and cause acid reflux. Even a lot of healthy foods have a high content of sugar. Edlund: What you do is what you become. You have to look at what people do physically, socially, mentally, spiritually. When populations do this kind of stuff, we tend to last a long time. There’s a balance to life. There’s a music to life in terms of not just physical activity and rest and when you eat, but our whole cycle—what we do in a 24-hour day. If we have some idea of what we’re built to do, rest becomes exciting, not boring, not a waste of time. If you tell people it’s something where you wake up and you’re partially reborn, your brain and body have reorganized. You grow new skin. You’ve done all this stuff to remake yourself—then it’s not just a waste of time. 

About Our Participants

Matthew Edlund, MD, MOH directs the Center for Circadian Medicine, and is an internationally recognized expert on rest and sleep, biological clocks, performance and regeneration health. His previous books include The Body Clock Advantage, Designed to Last and Psychological Time and Mental Illness. He writes on and practices Regeneration Health, a new approach to medical care whose goal is complete health—physical, mental, social and spiritual well being. He has worked as an Ivy League medical school professor, syndicated newspaper health columnist, hospital medical director, chief of a sleep lab and vice president of an Asian Art museum. He trained in internal medicine at University of California, San Diego and Massachusetts General Hospital, in occupational and public health at the Harvard School of Public Health, in sleep medicine at Brown University and in psychiatry at NYU Bellevue. He is a graduate of Amherst College, summa cum laude and Phi Beta Kappa and from SUNY Downstate, cum laude and Alpha Omega Alpha.

Steven Scheer, MD is a board-certified specialist in Sleep Medicine, treating patients with a variety of sleep disorders, including sleep apnea, snoring, restless legs, insomnia and narcolepsy. Scheer established Optimal Sleep Health after 10 years of being the medical director of two sleep centers in Cincinnati and Sarasota. Scheer graduated from Northwestern University Medical School in Chicago. He then studied Internal Medicine at Washington University in St. Louis, followed by residency in Physical Medicine and Rehabilitation at the University of Minnesota. Scheer has written widely and published two textbooks in his field. He is now an emeritus professor at the University of Cincinnati College of Medicine. Scheer pursued training in clinical sleep medicine in Cincinnati followed by additional training at Stanford University. He became board-certified in Sleep Medicine in 2001.

Glenn Adams, MD is a graduate of Loyola University School of Medicine. He completed his internal medicine residency at Southern Illinois University School of Medicine and pulmonary fellowship at Northwestern University School of Medicine. Adams is board-certified in internal medicine, pulmonary medicine and sleep medicine. He is currently a clinical assistant professor of medicine at Florida State University School of Medicine and is the medical director of the Sarasota Memorial Hospital Sleep Disorder Center. His practice is limited to sleep medicine.

Ashley Stewart, AADP is a holistic health coach and yoga instructor with a degree in Marketing and Business Administration from the University of Florida. She holds a 200 RYT and is a certified yoga instructor through the Marianne Wells Yoga School. The yoga teacher training led her to expanding her health knowledge and enrolling at the Institute of Integrative Nutrition, gaining a Health Coaching Certification in Holistic Health. Stewart is the co-founder and chief financial officer of Bliss Entourage, a company that guides people to self-empowerment. It currently has released a 6-week program to help you “jump start your life.” Stewart teaches yoga at several studios, including the Yoga Shack, Soul Yoga Sanctuary and IMG Academy.

Stacy Koski is a certified holistic health coach, registered nurse and a clean eating and organization specialist. She is a co-founder of Bliss Entourage. Her passion for helping people, and desire to use diet and lifestyle change as the means for primary health care led her to become a holistic health and nutrition coach. Stacy strongly believes in alternatives to medicine for the prevention and care of health-related issues. For her, life is about creating more quality and satisfaction in all aspects of life, from food and drinks to the experiences we encounter.