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Sleep more, function better

Aug 22, 2022

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Lack of sleep can affect multiple facets in both our physical and mental health. Studies have linked sleep deprivation to weight gain, chemical imbalances, thinking of food as a reward, and slower mental processes. It has been proven over and over that getting better rest is integral to lowering stress and increasing our ability to function in optimum health. But how do we actually achieve better sleep?

Having struggled to get adequate sleep myself, this topic touches me personally. I’ve researched and worked to improve my own rest, and learned a lot of information, tips and ideas revolving around sleep. In this episode, I share them with you, including several physiological factors. I discuss ideas and tips for changing our thought processes around rest, correcting mistakes we might be making regarding sleep, and implementing ways to increase our restorative sleep. I hope the information I share helps each of you sleep more and function better.

“Without enough sleep, we tend to be more irritable and our brains just don’t function as well… We make more mistakes, things take longer to do and we are just not as bright and as capable as we can be. However, even though we know all that, most of us continue not to get enough sleep.” – Dr. Sara Dill

What You’ll Learn

  • Sleep linked to various diseases, especially obesity
  • Overeating and sleep deprivation
  • Listening to your body
  • Signs you’re not getting enough sleep
  • How to get more rest
  • Changing how you think about sleep
  • Mistakes we make regarding rest
  • Ideas and tips for improving sleep

Contact Info and Recommended Resources

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Connect with Sara Dill, MD, The Doctor’s Coach

Transcript

I’m Dr. Sara Dill, and this is the Stress-Less Physician podcast, Episode Number 28. Welcome to the Stress-Less Physician podcast. I’m your host, Dr. Sara Dill, MD. Using my unique combination of coaching and mindfulness tools, I will teach you practical ways to reduce your stress level, feel happier at work, and create a better balance between your medical career and personal life. If you are a busy practicing physician who wants to design a life and medical career that feels good to you, you are in the right place.

Hey everyone, welcome back to the podcast. I am so excited to talk to you today about “Sleep”. This is something near and dear to my heart that I, full disclosure, I’m still working on, but my sleep is so much better than it used to be, and a lot of that is because I really have been working on how much of a priority I make sleep.

So, a lot of this podcast of course, is going to talk about the mindset around sleep and how you can really prioritize getting sleep in a way that allows you to get more sleep. I’m going to talk a little bit about things that get in the way of sleep too, but a lot of that is something you may need to research on your own, depending on some of the causes of why you might not be getting enough sleep, the specifics of it.

So, I want to talk about something that most of us know, which is the importance of sleep, of enough or adequate sleep and yet, very few of us actually do, which is to get enough sleep on a regular, if not, daily basis. And the reason I was thinking about doing this podcast now is that sleep has come up a lot, both in coaching some clients recently, as well as in my personal life.

I just went out with some girlfriends and we were all talking about sleep. I have this ring, it’s called an Oura ring, spelled O-U-R-A, and I love it. I’ve had it—I think for almost a year now, and it has really provided good data for me that supports what I already know, which is how terrible I feel when I don’t get enough sleep.

And I like data, I don’t know about you, but I like to see numbers, I like to sort of look at trends over time and it’s helped me really prioritize my sleep in a more concrete way. Just last week, I was talking to a coaching client who’s also been trying to get more sleep, right? And yet, it was so funny, and this is one of the benefits of coaching, she kept saying, and I don’t even think she realized it, she kept saying that getting too little sleep is just inevitable sometime, right? Like she was just telling me the news, she was just stating a fact.

And if you know the self-coaching model that I use, right? If that’s your thought, “Getting too little sleep is just inevitable sometime,” it’s probably going to lead to the result—you got it—that getting too little sleep is inevitable, right? That if you believe that it’s just not possible to always get enough sleep or that it’s inevitable that you won’t get to bed on time or get enough sleep, your results are also going to demonstrate that.

And again, I just want to say I’m still working on this and I still have to really look at what am I thinking that’s preventing me from going to bed, when I say I’m going to go to bed and how can I continue to improve this? And the more I get enough sleep, the better I feel and the more evidence I have of why it’s important.

And I also want to give a shout out to my boyfriend because he is very committed to my getting enough sleep, and that makes it so much easier. So, then having to be with someone who tends to stay up later than I do, and this way, he’s committed to my getting enough sleep, I’m committed to getting enough sleep, the only one that’s not committed seems to be my puppy and we’re working on it. So, my puppy is one of the reasons I sometimes don’t sleep as much as I plan to.

So, I just wanted to do a little background too, because even though most of us know how important sleep is, I don’t think I realized exactly how important it was. A book that you might want to skim or read, if you are interested in this subject is a book called Why We Sleep by Matthew Walker, who’s a PhD and I’ll put a link to it in the show notes. And I think I’m actually going to re-read it; it’s been a while since I’ve read it. And it definitely gives me a lot of evidence for why sleep is important and helps me reinforce my desire to prioritize sleep.

But I went online, I did a little research and... just wanted to list some of the general fairly well documented facts about sleep. So, getting adequate sleep is important in terms of maintaining a healthy weight, lowering your stress levels, improving mood, and increasing your motor coordination, as well as having a lot of benefits related to cognition and memory formation.

There’s good research that documents that insufficient sleep, which typically is considered less than six or seven hours a night, has been linked to the development and management of a number of chronic diseases, including: Type II diabetes, cardiovascular disease, obesity and depression. Depression is a little tricky with sleep deprivation because a sign of depression can be actually either insomnia or oversleeping, but certainly, people with depression tend to have insufficient sleep quite frequent.

A lot of you know that I used to coach on weight loss, and so I’m actually very interested in obesity and its connection to insufficient sleep. And again, sleep is very important for the production and regulation of a lot of our hormones and the way that insufficient sleep increases overeating and is linked to obesity, is via triggering increased levels of ghrelin, which make you hungry and decrease levels of leptin, which signal satiety or fullness, thus, leading to increased hunger and appetite.

So, most of us have had that experience of just being hung or hungrier on days where we haven’t had enough sleep. Specifically, this is relevant to physicians and trainees in terms of residency or working night shifts or overnights, or being on call. A lot of us would snack more, right? And eat more, and it’s understandable because it makes sense from a hormonal standpoint as well. So, when anyone is sleep deprived, again, your ghrelin levels spike and the leptin levels fall, and you’re going to have increased hunger.

It’s also interesting that insufficient sleep affects parts of the brain that actually determine how we think about food. So, in studies of people who were sleep deprived, brain activity is enhanced in areas that are involved in viewing food or thinking about food as a positive reward, and the way that happens is it seems that endocannabinoids, right? Our own internal cannabinoids are produced in increased levels following sleep deprivation, specifically, one called 2-AG.

And so, these, again, are active in brain reward systems and increase our hedonic drive, right? Our drive to get enjoyment or pleasure. And so, with sleep deprivation, those hormones go up, and so we have this stronger urge to seek out and eat foods that we enjoy, so pleasurable foods and overeating as well.

Again, I find this really interesting, there was another study that found increased appetite for high calorie foods in particular, in people who didn’t get enough sleep. There’s probably an evolutionary reason or advantage for this. My guess would be that if you are sleep deprived, you maybe need more drive to hunt or you need more energy to compensate for it, I don’t know.

Interesting to think about, but it definitely supports my own personal experience and those of my friends and also coaching clients. In the end without enough sleep, we tend to be more irritable and our brains just don’t function as well, right? We make more mistakes, things take longer to do, and we are just not as bright and as capable as we can be.

However, even though we know all that, most of us continue not to get enough sleep, which is so interesting. Especially we physicians, we are a group of very smart people, we like research, we know the data, and yet it sometimes seems as if it’s beyond our own control, right? Like we know this and yet we don’t do better.

There’s a saying, I like, “To know better and not do better means not to really know,” right? Once you’ve really internalized the importance of something or the truth of something, ideally your behavior should be in alignment. So, we must be believing other things that don’t create a sense of full commitment to the idea, to the importance, to the value of getting a good night’s sleep.

And that’s what’s so interesting to me in terms of coaching, both self-coaching and coaching other people, is to find out what are we believing about sleep or sleep deprivation or inadequate sleep that is allowing us to be okay with not getting enough sleep.

     So, in general, for most adults, and of course, there are outliers, adequate sleep, or sort of the goal sleep you want, is about seven to nine hours. The research is a little bit spotty on this, there’s some studies that say six to eight, some that say seven to nine, of course, there’s a broad curve, there are people who legitimately can get by and thrive with less than six hours of sleep and folks that can sleep more.

     But it’s interesting that many studies show increased mortality on either end of the spectrum, right? So, less than six or seven hours for sure, but also more than 9 or 10 hours of sleep. And of course, we know that often a lot of other diseases or other illnesses, a sign of them can be oversleeping or hypersomnolence. So, it’s not necessarily clear that sleeping more than 10 hours itself causes increased mortality, but more likely it’s a marker of other underlying diseases but it’s just interesting, right? There is an inverted curve of appropriate sleep.

What I would say is let’s not get hung up on the exact numbers. I would say, “Test it yourself,” how much sleep do you need to feel good? How much sleep do you need to wake up spontaneously and feel well rested to not be tired during the day, not have sort of daytime sleepiness? That’s the sweet spot. We always want to test it with ourselves, our bodies have wisdom about how much sleep they need.

When you listen to your body, it will tell you when you need to eat more or eat less when you’re full, when you’re hungry, when you’re thirsty, when you’re not, when you’re sleepy, when you’re not. But in general, I would aim for about seven to eight or seven to nine hours of sleep. How many of you listening to this podcast get seven plus hours of sleep a night on the regular.

I actually do these days, probably five nights a week. My goal is six nights a week, but at least five nights a week, I get seven to seven and a half hours of sleep a night, which is my sweet spot, it’s where I feel good. And I’ve been testing this out for the last several years and it’s pretty clear to me and to those around me.

So, signs you’re not getting enough sleep besides just the number of hours you’re clocking, is- irritability, right? Just plain old irritability or moodiness, crabbiness. Are you irritable a lot? Lack of motivation is another sign that you’re not getting enough sleep and that you’re fatigued. Do you just feel unmotivated at work and at home maybe?

Another sign of fatigue is trouble concentrating, right? Distractibility. Do you have difficulty starting and completing tasks? Like your charts, like your to-do list, like your inbox, like everything else, right? Do you just find that you’re distracted? Another big sign that you’re not getting enough sleep and that you have fatigue is daytime sleepiness or drowsiness. I remember in residency, I was dating someone who was a surgical resident and he literally fell asleep one time while changing into scrubs at the hospital, right? He just sat down and leaned against the wall and fell, right? That’s severe drowsiness, severe sleepiness.

     Another sign and this is related is- a decrease in your sleep latency, right? This is a number I get from my Oura ring that tracks my sleep, but it basically is a measure of how quickly do you fall asleep. In general, it should be about 10 to 20 minutes, I think. I still have decreased sleep latency; I tend to fall asleep these days within 5 to 10 minutes.

When I’m really stressed out though, it’s interesting, I have a lot of insomnia when I’m stressed, right? Sleep is often the first sign for me that I need to manage my mind better, that I need to take a look at what’s going on and how I’m thinking about it. And when I have insomnia, I often have a very difficult time falling asleep because of racing thoughts and worries and anxiety.

     So, that could be something interesting to look at. Other signs that you’re not getting enough sleep can be more vague, it can just be feeling listless or a lack of energy, feeling blah, or run-down, feeling sort of apathetic. Often, we have less patience when we’re fatigued and not getting enough sleep.

We have less empathy and less compassion; we also have decreased coordination in fine motor skills, and also, another sign of not getting enough sleep is feeling more stressed out, right? When I’m tired and fatigued, I have to coach myself so much more than when I don’t, right? Probably because I’m irritable and I’m moody.

So, I want to talk about how to get more sleep, right? There’s the technical component, and maybe since this podcast has already much longer than I thought I’ll do another podcast episode on that because I’ve certainly researched it. But I think we all know, right? A quiet room, a dark room, if you’re someone who has anxiety or worried that causes some insomnia working through that, if you are perimenopausal perhaps, or have other illnesses like sleep apnea or any other illnesses that impact your sleep, you want to work on those as well, right?

There’s lots of different tools and medications and techniques that can help with that. What I want to talk to is your mindset about sleep, I want to talk to you about your thoughts about sleep that will increase the likelihood of you getting more sleep, of getting adequate sleep, of getting seven and a half hours of sleep a night.

So, I want to ask you, do you value sleep? What are your thoughts about sleep? A thought that’s very common. I’ve seen it as a very frequent meme is, “I’ll sleep when I’m dead.” When I see that, I think, but yes, you might die earlier if you don’t sleep, right? That’s what the research shows. I don’t mean that you have to deprive yourself of fun and doing things but how do you value sleep? What do you think about it? How much sleep do you need? Honestly.

In residency and in medical school, and before, I really believed that I needed about five and a half to six hours of sleep, and that’s probably mostly what I got, but I was crabby a lot and irritable a lot and stressed out a lot, and I certainly wasn’t thriving. So, I would just say, “Can you question what you believe you need?” If you think you’re someone who only needs five or six hours of sleep, have you tried to get more sleep and see how you feel, see how your life functions, see how your day unfolds.

Have you noticed the difference between when you sleep more and when you don’t, are you excited to go to sleep? What are your thoughts about going to bed and getting sleep? Is getting seven or eight hours of sleep negotiable or is it just nice to have, or is it a non-negotiable for you? Do you think it’s inevitable that you just aren’t going to sleep enough and that’s okay?

Do you have a lot of drama or self-negotiation regarding sleep. Or are you always sort of telling yourself you should go to sleep and then you don’t want to or you rebel against your own sort of rules. GFD’s willpower to go to sleep. And I’ll just let you know that typically willpower is depleted and not available to us later at night, right? We’ve depleted our willpower during the day by making multiple decisions over time.

The answer to drama over sleeping is math, right? How much sleep do you need? If you need seven and a half hours of sleep, when do you need to be in bed to get that much sleep based on when you wake. I wake up a couple times during the night as well, so I need to factor that in. So, I actually spend longer in bed than I’m sleeping, right? So, let’s just do that math.

I want to offer you some of the thoughts I have about going to sleep, so these are the thoughts I think about before I go to bed that increase the probability that I will get to bed on time and go to sleep. I love the thought that everything good happens when I sleep. That book, Why We Sleep by Matthew Walker, really helped me with that. Thinking about the diseases that are more frequent when we are sleep deprived helps me believe in that thought, right? Everything good happens when I sleep.

I really believe I am no good tomorrow unless I get a good night’s sleep, right? That’s a thought I like to think before I go to bed. Sleep is one of the best parts of my day. I love my bed. I can’t wait to go to bed. I also just think sometimes it’s time for bed, this is when I go to bed, right? I sort of wind down; I like to be in bed by 9:30, that way I’m not negotiating.

It’s like brushing my teeth or washing my face at night or flossing my teeth, there’s no negotiation, it’s just what I do, right? That’s the point you get to when you don’t have to use willpower? I also like the thought Netflix, or currently, it’s Apple TV—is going to be here tomorrow, right? There’s no urgency, I don’t need to watch another show.

I will say that if I wake up in the middle of the night, which again happens, not infrequently for me, I like to have some different thoughts because I want to decrease the anxiety that sometimes I can create for myself about waking up at night. If I wake up at night and I think, “Oh my gosh, I have to fall back asleep, I’m not going to get enough sleep, I’m not going to be any good tomorrow. I’m likely to create more anxiety, which likely impairs my ability to fall back asleep. So, my thoughts, I think in the middle of the night often are a little bit different because they’re designed to sort of damp down the worry about sleep. That way it decreases or makes it less likely to amplify my insomnia.

So, I like to think no problem, my body knows how much sleep it needs, right? if I’m awake it’s not a problem. I like to think I can function tomorrow with whatever amount of sleep I get, it might not be ideal, but it’s going to be okay. I really know I can always make up my sleep tomorrow or the next day, and I can remind myself that waking up at night, isn’t an emergency, it’s going to be okay.

     And so, for those of you who do night shifts and on call, or maybe work 24-hour shifts, you might want to pick some different thoughts, right? And there are ways to compensate for having interrupted sleep or for having a regular sleep-wake cycles that minimize some of that.

So, the goal of this podcast is not to amplify your anxiety, or your thoughts about it. And of course, sometimes if our job requires us to stay up all night, you’re going to need to compensate for that. So, we always have the distinction between personal responsibility, right? What is under my control? What can I control and what can I not, right? Or how do I maybe want to improve or better my situation if I am in a situation or a workplace or any kind of situation, right?

Maybe you have young children, maybe you have a puppy, like I do, right? There are circumstances beyond your control that might impact your sleep. So how do we take ownership of that? How can we show up? How can we minimize the effect of that as well?

I want to also touch on, I think, mistakes that we make in getting more sleep. So, the first mistake—and again, I think these are sort of innocent, is waiting to feel tired to go to bed. I think it’s like waiting to be thirsty sometimes to drink water, it’s often too late, right? So, what if you didn’t have to wait to feel tired to go to bed.

Often, we’re distracted or we’re getting entertained, right? We’re watching TV or we’re reading, or we’re hanging out with our partner, our spouse, our kids, our friends, we’re doing something fun, right? and we’re not paying attention to our body signals. If there was nothing fun to do, would you go to bed? If the power were out and you had nothing to entertain you, would you go to sleep? So, what if you didn’t wait to feel tired to go to bed.

Second mistake, and this is very similar is “waiting to feel like going to bed.” So, I’m air quoting that, right? You probably aren’t going to feel like going to bed until you actually start believing in the importance of sleep, right? You may never feel like going to bed. A lot of us want more me time or quiet time. For a lot of us with busy lives, busy work lives, busy family lives, sometimes later on at night, is the only quiet time or sort of solo time we have. And so often, that’s when we’re negotiating with ourselves and just wanting a few more minutes, right?

That’s a thought, though, just a few more minutes or I need more me time, or this is my only quiet time. Those are thoughts that aren’t going to serve you, if you also want to get more quality sleep and more sleep in general. Can you get more me time or quiet time, another time when that isn’t at the expense of your sleep?

Maybe this is a time in your life when you’re just going to have less me time or less quiet time. If you want to prioritize getting seven or eight hours of sleep at night and see how you feel, you actually might need less quiet time if you get more sleep, that could be true as well.

And another mistake is that sometimes we just have the thought, “I just want to stay up later,” but that is a thought, right? That is a thought being generated by your primitive brain, and our primitive brain usually chooses short term pleasure over long term wellbeing, right? Our prefrontal cortex is the one that we make plans with, we decide I’m going to go to bed early tonight, right? Maybe we decide I’m not going to eat that thing or watch that show, whatever it is that sort of derails us and keeps us up later.

But in the moment, we have a desire, we get a dopamine hit, right? We want the pleasure temporary, short term, though, it is, of staying up later. So, I just want you to spot that as a thought, “I would just want to stay up later,” I think of it as a thought error, right? Don’t be fooled. If you were committed to long term wellbeing over a short-term pleasure, when would you go to bed? What would you do? How would you change your nighttime routine?

And I just want to end on some interesting tidbits. When prepping for this, I did a little research because I always like to see what’s in the news, what’s in the literature. There was an interesting article out of Baylor in 2018, that showed that people who wrote out a to-do list before bed, fell asleep 9 to 10 minutes faster than those who just journaled ad wrote down everything they’d done the day before.

So, you could try that if you’re someone who has a hard time falling asleep, write out your to-do list for tomorrow. And I want to say, I found this interesting because this is what I do if I wake up in the middle of the night with sort of a to-do list in my mind, right? Oh my gosh, I have to remember to do this tomorrow, or if I have anxiety regarding the next day, I will briefly sit up. I always have a notepad and pen next to my bed in my bedside table, and I write it down. I try not to even turn the light on, right? I write down my to-do list, I write down whatever’s in my head, so that I don’t have to worry about remembering it, another thought. And it allows me to go back to sleep much faster and more easily.

And I also just wanted to mention again, that idea that people who sleep too long, rather than getting anxious about it or worrying about what’s the exact amount of sleep is, can you just trust your own body? But there was some more evidence that again, sleeping long, right over sleeping is a symptom that by itself, sleep itself doesn’t kill people.

Getting the right amount of sleep for you is going to be a major factor in your best performance, your best health, your best appearance, your best life, how you feel moment to moment. So I don’t want you to over worry about the technical amount of sleep, I just want you to experiment, test it out, see how you feel.

And again, this is still a work in progress for me. I don’t always maintain the same bedtime, I stay up late, sometimes my puppy wakes me up. I have learned sadly that if I eat or drink too close to bedtime, I sleep poorly, right? That’s what the numbers show me, that’s what my own body shows me, but I’m learning and I am improving.

And my aim is to get good enough sleep often enough, right? Not perfection. For me, that’s about seven and a half hours of sleep by every six nights a week, that’s my goal. And so, I’ll just ask you, what would be different for you if you got enough or the ideal amount of sleep six nights a week? What if sleep was a non-negotiable for you? What  if not getting enough sleep wasn’t acceptable to you? right? What if not getting enough sleep is never inevitable? Right? What if you just weren’t okay with it, what would change?

Alright, so fun hanging out with you, that’s what I have for you today. I thought this would be much shorter, but apparently, I have a lot to say about sleep and I will just say, I am so much better when I get enough sleep, I don’t have to coach myself, I feel better, I enjoy my day more, I enjoy seeing patience, I enjoy all of it, right? And I’m more enjoyable to be around.”

So, I would just encourage you, look at your thoughts about sleep, look at your thoughts about going to bed. What’s one thought you could consider believing that would improve the amount of sleep you’re getting? And let’s test it out. Let’s find out how you can get enough sleep to be the best version of you every night.

All right, feel free to send me an email, any questions, comments, feedback, if you have anything you want to hear me talk about on the podcast, send me an email as well.

I read and answer all my own emails, again my email is Sara S-A-R-A @saradill.com, or you can go to my website, www.saradill.com and just click the contact me button. Okay, can’t wait to talk to you next week, bye.

If you are a busy practicing physician ready to start feeling less stressed, enjoy work more, and learn how to create a more balanced and sustainable medical practice and life, sign up for a consult call with me at www.saradill.com. That’s S-A-R-A-D-I-L-L.com. It would be my privilege and pleasure to work with you.

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